Keratomycosis is a vision-threatening disease caused by fungal infection of the cornea. Fungal keratitis is an emerging cause of corneal disease in horses, with the reported incidence in North America rising from 13% of keratitis cases in the 40 years preceding 2006 to approximately 25% in 2013. Keratomycosis is particularly prevalent in tropical or subtropical environments, such as the southern United States. For example, in the state of Alabama, keratomycosis accounted for 40% of the equine corneal disease caseload presenting to the Auburn University Large Animal Teaching Hospital (AULATH) during the 2012-2013 academic year.
Equines, in particular horses, are believed to be prone to fungal ocular infections due to their large globe size, unique orbital shape and resultant globe exposure, suspected tear film instability and living environment. Fungi are ubiquitous in the equine environment (e.g. in hay, soil and bedding) and are also part of the normal ocular surface microbiota of the horse. More than 30 genera of fungi have been implicated in equine keratomycosis, with the most common being the filamentous fungi Aspergillus, Fusarium and Penicillium and the yeast Candida. 
Development of keratomycosis requires disruption of the normal defense mechanisms of the equine cornea and conjunctiva such as the intact corneal epithelium, normal bacterial microbiota, flushing of commensal organisms through tear flow and eyelid movement, and tear film macrophages, lysozymes and immunoglobulins. Following disruption of one or more of these defense mechanisms, commensal or introduced (environmental) fungi are able to adhere to the cornea, proliferate and invade the conical stroma. Fungal organisms, damaged keratocytes and inflammatory cells attracted to the area by the fungi then release proteases which facilitate vertical movement of fungi through the conical stroma and Descemet's membrane. This may ultimately result in fungal migration into the anterior chamber, lens and iris, with subsequent development of severe endophthalmitis.
Clinical manifestations of equine keratomycosis include corneal ulceration (with or without keratomalacia), conical microerosions, superficial punctate keratitis, stromal abscessation, stromal plaque formation, and conical perforation with iris prolapse. Of these, stromal ulcerative keratomycosis is the most common manifestation, comprising 50.80% of reported cases of equine keratomycosis.
Furthermore, equine keratomycosis is a source of severe morbidity in horses Fungal organisms and infiltrating immune cells are capable of initiating both vigorous inflammatory responses and protease overproduction in the cornea. In turn, this may lead to the development of acute complications in affected eyes including rapid keratomalacia (melting of the cornea), unresolving ulceration, abscess formation, uncontrolled anterior uveitis, endophthalmitis and corneal perforation. Long term sequelae may include corneal scarring, cataract or synechiae formation, phthisis bulbi and vision loss. In various case studies reporting outcomes in horses affected with equine keratomycosis, success rates (as defined by restoration of functional vision and/or ocular survival) in these equine populations varied from 50% to greater than 90%, with the majority of case series reporting retention of functional vision in <70% of cases. In light of the severity of potential sequelae of keratomycosis described above, these success rates are undesirable.
Equine keratomycosis treatment is challenging, prolonged and expensive and requires compliance from both horses and their handlers. The average duration of treatment varies from 48 to 72 days, and up to 192 days of treatment has been described. The average time required in the hospital varies from 15 to 21 days, which represents an investment of thousands of dollars and a source of considerable stress for the horse and has been defined as a risk factor for development of colic.
Fungal keratitis can be treated with either medical therapy alone or a combination of medical and surgical therapy. Although surgical procedures are immediately indicated in animals with acute corneal perforation or in those with imminent or pre-existing rupture of a stromal abscess into the anterior chamber, medical treatment with antifungal agents is a major therapeutic option in most cases, whereby success depends on the agent's ability to penetrate the conical epithelium and achieve therapeutic concentrations in the anterior segment of the eye. In order to reach therapeutic concentrations in the cornea and anterior chamber, treatment typically involves application of topical medication every 1-2 hours in acute disease, decreasing ultimately to every 6-12 hours, with potential concurrent administration of oral antifungals, anti-inflammatory agents, and antibiotics.
Voriconazole is a second generation triazole antifungal drug and is a relatively new antifungal agent in equine and human ophthalmology. Despite the excellent corneal penetration of voriconazole, several additional barriers exist in the eye which must be overcome in order to obtain higher or more sustained therapeutic voriconazole concentrations in the cornea and anterior chamber following topical delivery. Upon topical administration, pre-corneal factors and anatomical barriers negatively affect the bioavailability of topical formulations. Anatomical drug transport barriers include corneal and conjunctival epithelial tight junctions and clearance from the vasculature in the conjunctiva. Furthermore, despite effective corneal penetration, sustained drug delivery is still severely limited by ocular barriers and this effect is short lived, with studies is rabbits demonstrating the need for administration of voriconazole every 30 minutes in order to achieve a sustained high level of voriconazole in the anterior chamber.
Therefore, there exists a need for new compositions and formulations that provide therapeutic options for treating keratomycosis. Accordingly, the present disclosure provides veterinary formulations comprising a therapeutically effective amount of voriconazole, as well as kits, and also methods of using the formulations and kits, which exhibit desirable properties and provide related advantages for improvement in administration and treatment of keratomycosis.
The present disclosure provides veterinary formulations comprising a therapeutically effective amount of voriconazole and a polymer. The disclosure also provides kits comprising voriconazole and a polymer, as well as methods of treating a fungal infection in an animal, said method comprising the step of administering a veterinary formulation comprising a therapeutically effective amount of voriconazole and a polymer to the animal utilizing the veterinary formulations and kits of the present disclosure.
The veterinary formulations, kits, and methods according to the present disclosure provide several advantages compared to other formulations and methods known in the art. First, a sustained-release veterinary formulation comprising voriconazole has great potential to improve comfort and ultimate outcome for animals suffering from keratomycosis, especially horses. Second, such a formulation can provide a treatment which would be available to all affected animals, regardless of budget, as it could be administered in the field. Third, the formulation, given via subconjunctival injection, would negate the need for frequent topical application of voriconazole to animals. This would result in minimizing stress in patients and improving compliance by decreasing the volume, frequency, and cost of medication required for treatment. Fourth, utilization of thermogel polymers (e.g., thermosensitive biodegradable hydrogels or ‘thermogels’) can advantageously be administered as a liquid, followed by conversion to a gel deposit upon reaching the appropriate temperature. As a result, the thermogel polymers can maintain a sustained release of drug at the site of administration in the animal, for example over weeks to months. The sustained release of voriconazole to an animal suffering from keratomycosis would increase the local bioavailability of the medication, decrease systemic side effects, and improve client compliance.
The following numbered embodiments are contemplated and are non-limiting:
1. A veterinary formulation comprising i) a therapeutically effective amount of voriconazole and ii) a polymer.
2. The veterinary formulation of clause 1, wherein the veterinary formulation further comprises an alcohol.
3. The veterinary formulation of clause 2, wherein the alcohol is ethanol.
4. The veterinary formulation of any one of clauses 1 to 3, wherein the veterinary formulation further comprises a second therapeutic agent.
5. The veterinary formulation of clause 4, wherein the second therapeutic agent is selected from the group consisting of an oral antifungal agent, an anti-inflammatory agent, and an antibiotic.
6. The veterinary formulation of any one of clauses 1 to 5, wherein the polymer is a thermogel polymer.
7. The veterinary formulation of clause 6, wherein the thermogel polymer is selected from the group consisting of poly(ethylene glycol) (PEG), poly(propylene glycol) (PPG), poly (N-isopropyl acrylamide) (PNIPAAm), poly(N,N-diethyl acrylamide) (PDEAM), poly(N-ethyl methacrylamide) (PNEMAM), poly(methyl vinyl ether) (PMVE), poly(2-ethoxyethyl vinyl ether) (PEOVE), poly(N-vinyl isobutyramide) (PNVIBAM), poly(N-vinyl n-butyramide) (PNVBAM), poly(N-vinyl caprolactam) (PNVCa), and poly (hydroxypropyl methacrylamide) (HPMA), poly(lactide-co-glycolide)-b-poly(ethylene glycol)-b-poly(lactide-co-glycolide) (PLGA-PEG-PLGA), poly(DL-lactide)-b-Poly(ethylene glycol)-b-Poly(DL-lactide) (P(DL)LA-PEG-P(DL)LA), and poly(lactide-co-caprolactone)-b-Poly(ethylene glycol)-b-Poly(lactide-co-caprolactone) (PLCL-PEG-PLCL).
8. The veterinary formulation of clause 6, wherein the thermogel polymer is a combination of two or more thermogel polymers selected from the group consisting of poly(ethylene glycol) (PEG), poly(propylene glycol) (PPG), poly (N-isopropyl acrylamide) (PNIPAAm), poly(N,N-diethyl acrylamide) (PDEAM), poly(N-ethyl methacrylamide) (PNEMAM), poly(methyl vinyl ether) (PMVE), poly(2-ethoxyethyl vinyl ether) (PEOVE), poly(N-vinyl isobutyramide) (PNVIBAM), poly(N-vinyl n-butyramide) (PNVBAM), poly(N-vinyl caprolactam) (PNVCa), and poly (hydroxypropyl methacrylamide) (HPMA), poly(lactide-co-glycolide)-b-poly(ethylene glycol)-b-poly(lactide-co-glycolide) (PLGA-PEG-PLGA), poly(DL-lactide)-b-Poly(ethylene glycol)-b-Poly(DL-lactide) (P(DL)LA-PEG-P(DL)LA), and poly(lactide-co-caprolactone)-b-Poly(ethylene glycol)-b-Poly(lactide-co-caprolactone) (PLCL-PEG-PLCL).
9. The veterinary formulation of clause 6, wherein the thermogel polymer is PLGA-PEG-PLGA.
10. The veterinary formulation of clause 9, wherein the PLGA-PEG-PLGA has a molecular weight of 1100:1000:1100 Da.
11. The veterinary formulation of clause 9, wherein the PLGA-PEG-PLGA has a molecular weight of 1500:1500:1500 Da.
12. The veterinary formulation of clause 9, wherein the PLGA-PEG-PLGA has a molecular weight of 1600:1500:1600 Da.
13. The veterinary formulation of clause 9, wherein the PLGA-PEG-PLGA has a molecular weight of 1700-1500-1700 Da.
14. The veterinary formulation of clause 9, wherein the PLGA-PEG-PLGA is a combination of two different PLGA-PEG-PLGA compositions, wherein the first PLGA-PEG-PLGA composition and the second PLGA-PEG-PLGA composition are selected from the group consisting of a PLGA-PEG-PLGA with a molecular weight of 1100:1000:1100 Da, a PLGA-PEG-PLGA with a molecular weight of 1500:1500:1500 Da, a PLGA-PEG-PLGA with a molecular weight of 1600:1500:1600 Da, and a PLGA-PEG-PLGA with a molecular weight of 1700-1500-1700 Da.
15. The veterinary formulation of clause 9, wherein the PLGA-PEG-PLGA is a combination of two different PLGA-PEG-PLGA compositions, wherein the first PLGA-PEG-PLGA composition has a molecular weight of 1100:1000:1100 and the second PLGA-PEG-PLGA composition has a molecular weight of 1500:1500:1500.
16. The veterinary formulation of clause 15, wherein the ratio of the first PLGA-PEG-PLGA composition and the second PLGA-PEG-PLGA composition is about 1:1.
17. The veterinary formulation of clause 15, wherein the ratio of the first PLGA-PEG-PLGA composition and the second PLGA-PEG-PLGA composition is about 2:1.
18. The veterinary formulation of clause 15, wherein the ratio of the first PLGA-PEG-PLGA composition and the second PLGA-PEG-PLGA composition is about 3:1.
19. The veterinary formulation of clause 9, wherein the PLGA-PEG-PLGA is at a ratio of 1:1 (lactide:glycolide).
20. The veterinary formulation of clause 9, wherein the PLGA-PEG-PLGA is at a ratio of 2:1 (lactide:glycolide).
21. The veterinary formulation of clause 9, wherein the PLGA-PEG-PLGA is at a ratio of 3:1 (lactide:glycolide).
22. The veterinary formulation of clause 9, wherein the PLGA-PEG-PLGA is at a ratio of 15:1 (lactide:glycolide).
23. The veterinary formulation of clause 6, wherein the thermogel polymer is P(DL)LA-PEG-P(DL)LA.
24. The veterinary formulation of clause 23, wherein the P(DL)LA-PEG-P(DL)LA has a molecular weight of 1700-1500-1700 Da.
25. The veterinary formulation of clause 6, wherein the thermogel polymer is PLCL-PEG-PLCL.
26. The veterinary formulation of clause 25, wherein the PLCL-PEG-PLCL has a molecular weight of 1700-1500-1700 Da.
27. The veterinary formulation of clause 25, wherein the PLGA-PEG-PLGA is at a ratio of 60:40 CL:LA.
28. The veterinary formulation of clause 6, wherein the thermogel polymer has a gelation set point at a temperature of about 30° C. to about 40° C.
29. The veterinary formulation of clause 6, wherein the thermogel polymer has a gelation set point at a temperature of about 33° C. to about 44° C.
30. The veterinary formulation of clause 6, wherein the thermogel polymer has a gelation set point at a temperature of about 33° C. to about 36° C.
31. The veterinary formulation of clause 6, wherein the thermogel polymer has a gelation set point at a temperature of about 31° C. to about 42° C.
32. The veterinary formulation of clause 6, wherein the thermogel polymer has a gelation set point at a temperature of about 27° C. to about 45° C.
33. The veterinary formulation of any one of clauses 1 to 32, wherein the veterinary formulation further comprises one or more dissolution additives.
34. The veterinary formulation of clause 33, wherein the one or more dissolution additives is selected from the group consisting of N-methylpyrolidinone (NMP), mannitol, and mPEG-P (DL) La.
35. The veterinary formulation of clause 34, wherein the mPEG-P (DL) La is mPEG-P (DL) La (2000-2200 Da).
36. The veterinary formulation of any one of clauses 1 to 35, wherein the veterinary formulation is single-use formulation.
37. The veterinary formulation of any one of clauses 1 to 35, wherein the veterinary formulation is a multi-use formulation.
38. The veterinary formulation of any one of clauses 1 to 37, wherein the veterinary formulation is a controlled release formulation.
39. The veterinary formulation of clause 38, wherein the controlled release formulation releases voriconazole from veterinary formulation for about 7 days.
40. The veterinary formulation of clause 38, wherein the controlled release formulation releases voriconazole from veterinary formulation for about 10 days.
41. The veterinary formulation of clause 38, wherein the controlled release formulation releases voriconazole from veterinary formulation for about 14 days.
42. The veterinary formulation of clause 38, wherein the controlled release formulation releases voriconazole from veterinary formulation for about 21 days.
43. The veterinary formulation of clause 38, wherein the controlled release formulation releases voriconazole from veterinary formulation for about 28 days.
44. The veterinary formulation of any one of clauses 1 to 44, wherein the veterinary formulation is an injectable formulation.
45. The veterinary formulation of clause 44, wherein the injectable formulation is configured for injection in a subconjunctival space (SCS).
46. The veterinary formulation of clause 45, wherein the SCS is a dorsal bulbar SCS.
47. The veterinary formulation of clause 45, wherein the SCS is a ventral bulbar SCS.
48. A kit comprising i) voriconazole and ii) a polymer.
49. The kit of clause 48, wherein the kit further comprises an alcohol.
50. The kit of clause 49, wherein the alcohol is ethanol.
51. The kit of any one of clauses 48 to 50, wherein the polymer is a thermogel polymer.
52. The kit of clause 51, wherein the thermogel polymer is selected from the group consisting of poly(ethylene glycol) (PEG), poly(propylene glycol) (PPG), poly (N-isopropyl acrylamide) (PNIPAAm), poly(N,N-diethyl acrylamide) (PDEAM), poly(N-ethyl methacrylamide) (PNEMAM), poly(methyl vinyl ether) (PMVE), poly(2-ethoxyethyl vinyl ether) (PEOVE), poly(N-vinyl isobutyramide) (PNVIBAM), poly(N-vinyl n-butyramide) (PNVBAM), poly(N-vinyl caprolactam) (PNVCa), and poly (hydroxypropyl methacrylamide) (HPMA), PLGA-PEG-PLGA, P(DL)LA-PEG-P(DL)LA, and PLCL-PEG-PLCL.
53. The kit of clause 51, wherein the thermogel polymer is a combination of two or more thermogel polymers selected from the group consisting of poly(ethylene glycol) (PEG), poly(propylene glycol) (PPG), poly (N-isopropyl acrylamide) (PNIPAAm), poly(N,N-diethyl acrylamide) (PDEAM), poly(N-ethyl methacrylamide) (PNEMAM), poly(methyl vinyl ether) (PMVE), poly(2-ethoxyethyl vinyl ether) (PEOVE), poly(N-vinyl isobutyramide) (PNVIBAM), poly(N-vinyl n-butyramide) (PNVBAM), poly(N-vinyl caprolactam) (PNVCa), and poly (hydroxypropyl methacrylamide) (HPMA), PLGA-PEG-PLGA, P(DL)LA-PEG-P(DL)LA, and PLCL-PEG-PLCL.
54. The kit of clause 51, wherein the thermogel polymer is PLGA-PEG-PLGA.
55. The kit of clause 54, wherein the PLGA-PEG-PLGA has a molecular weight of 1100:1000:1100 Da.
56. The kit of clause 54, wherein the PLGA-PEG-PLGA has a molecular weight of 1500:1500:1500 Da.
57. The kit of clause 54, wherein the PLGA-PEG-PLGA has a molecular weight of 1600:1500:1600 Da.
58. The kit of clause 54, wherein the PLGA-PEG-PLGA has a molecular weight of 1700-1500-1700 Da.
59. The kit of clause 54, wherein the PLGA-PEG-PLGA is a combination of two different PLGA-PEG-PLGA compositions, wherein the first PLGA-PEG-PLGA composition has a molecular weight of 1100:1000:1100 and the second PLGA-PEG-PLGA composition has a molecular weight of 1500:1500:1500.
60. The kit of clause 59, wherein the ratio of the first PLGA-PEG-PLGA composition and the second PLGA-PEG-PLGA composition is about 1:1.
61. The kit of clause 59, wherein the ratio of the first PLGA-PEG-PLGA composition and the second PLGA-PEG-PLGA composition is about 2:1.
62. The kit of clause 59, wherein the ratio of the first PLGA-PEG-PLGA composition and the second PLGA-PEG-PLGA composition is about 3:1.
63. The kit of clause 54, wherein the PLGA-PEG-PLGA is at a ratio of 1:1 (lactide:glycolide).
64. The kit of clause 54, wherein the PLGA-PEG-PLGA is at a ratio of 2:1 (lactide:glycolide).
65. The kit of clause 54, wherein the PLGA-PEG-PLGA is at a ratio of 3:1 (lactide:glycolide).
66. The kit of clause 54, wherein the PLGA-PEG-PLGA is at a ratio of 15:1 (lactide:glycolide).
67. The kit of clause 51, wherein the thermogel polymer is P(DL)LA-PEG-P(DL)LA.
68. The kit of clause 67, wherein the P(DL)LA-PEG-P(DL)LA has a molecular weight of 1700-1500-1700 Da.
69. The kit of clause 51, wherein the thermogel polymer is PLCL-PEG-PLCL.
70. The kit of clause 69, wherein the PLCL-PEG-PLCL has a molecular weight of 1700-1500-1700 Da.
71. The kit of clause 69, wherein the PLGA-PEG-PLGA is at a ratio of 60:40 CL:LA.
72. The kit of clause 51, wherein the thermogel polymer has a gelation set point at a temperature of about 30° C. to about 40° C.
73. The kit of clause 51, wherein the thermogel polymer has a gelation set point at a temperature of about 33° C. to about 44° C.
74. The kit of clause 51, wherein the thermogel polymer has a gelation set point at a temperature of about 33° C. to about 36° C.
75. The kit of clause 51, wherein the thermogel polymer has a gelation set point at a temperature of about 31° C. to about 42° C.
76. The kit of clause 51, wherein the thermogel polymer has a gelation set point at a temperature of about 27° C. to about 45° C.
77. The kit of any one of clauses 48 to 76, wherein the kit further comprises one or more dissolution additives.
78. The kit of clause 77, wherein the one or more dissolution additives is selected from the group consisting of N-methylpyrolidinone (NMP), mannitol, and mPEG-P (DL) La.
79. The kit of clause 78, wherein the mPEG-P (DL) La is mPEG-P (DL) La (2000-2200 Da).
80. The kit of any one of clauses 48 to 79, wherein the polymer is a liquid.
81. The kit of clause 80, wherein the liquid polymer is configured to form a gel deposit upon administration to an animal.
82. The kit of clause 81, wherein the gel deposit is formed at a temperature of about 30° C. to about 40° C.
83. The kit of clause 81, wherein the gel deposit is formed at a temperature of about 33° C. to about 44° C.
84. The kit of clause 81, wherein the gel deposit is formed at a temperature of about 33° C. to about 36° C.
85. The kit of clause 81, wherein the gel deposit is formed at a temperature of about 31° C. to about 42° C.
86. The kit of clause 81, wherein the gel deposit is formed at a temperature of about 27° C. to about 45° C.
87. The kit of any one of clauses 48 to 86, wherein the kit further comprises instructions for combination of the voriconazole and the polymer.
88. A method of treating a fungal infection in an animal, said method comprising the step of administering a veterinary formulation comprising i) a therapeutically effective amount of voriconazole and ii) a polymer to the animal.
89. The method of clause 88, wherein the veterinary formulation is the veterinary formulation of any one of clauses 1-47.
90. The method of clause 88, wherein the veterinary formulation is formed from the kit of any one of clauses 48-87.
91. The method of any one of clauses 88-90, wherein the fungal infection is caused by an Aspergillus species.
92. The method of any one of clauses 88-90, wherein the fungal infection is caused by a Fusarium species.
93. The method of any one of clauses 88-90, wherein the fungal infection is caused by a Penicillium species.
94. The method of any one of clauses 88-90, wherein the fungal infection is caused by a Candida species.
95. The method of any one of clauses 88-94, wherein the fungal infection is an ocular infection.
96. The method of any one of clauses 88-95, wherein the fungal infection causes keratomycosis in the animal.
97. The method of any one of clauses 88-96, wherein the animal is an equine.
98. The method of clause 97, wherein the equine is a horse.
99. The method of clause 97, wherein the equine is a donkey.
100. The method of clause 97, wherein the equine is a zebra.
101. The method of any one of clauses 88-90, wherein the animal is a feline.
102. The method of any one of clauses 88-90, wherein the animal is a canine.
103. The method of any one of clauses 88-90, wherein the animal is a camelid.
104. The method of clause 103, wherein the camelid is selected from the group consisting of dromedary camels, Bactrian camels, wild Bactrian camels, llamas, alpacas, vicuñas, and guanacos.
105. The method of clause 103, wherein the camelid is a llama.
106. The method of clause 103, wherein the camelid is an alpaca.
107. The method of any one of clauses 88-106, wherein the administration is an injection.
108. The method of clause 107, wherein upon the injection to the animal, the polymer of the veterinary formulation is a liquid.
109. The method of clause 108, wherein the liquid polymer forms a gel deposit in the animal subsequent to the injection.
110. The method of clause 109, wherein the gel deposit is formed at a temperature of about 30° C. to about 40° C.
111. The method of clause 109, wherein the gel deposit is formed at a temperature of about 33° C. to about 44° C.
112. The method of clause 109, wherein the gel deposit is formed at a temperature of about 33° C. to about 36° C.
113. The method of clause 109, wherein the gel deposit is formed at a temperature of about 31° C. to about 42° C.
114. The method of clause 109, wherein the gel deposit is formed at a temperature of about 27° C. to about 45° C.
115. The method of any one of clauses 107 to 114, wherein the injection is in a subconjunctival space (SCS).
116. The method of clause 115, wherein the SCS is a dorsal bulbar SCS.
117. The method of clause 115, wherein the SCS is a ventral bulbar SCS.
118. The method of any one of clauses 88 to 117, wherein the voriconazole diffuses through a cornea of the animal.
119. The method of any one of clauses 88 to 118, wherein the voriconazole diffuses through a sclera of the animal.
120. The method of any one of clauses 88 to 119, wherein the administration provides a concentration of voriconazole greater than the target minimum inhibitory concentration for about 7 days.
121. The method of any one of clauses 88 to 119, wherein the administration provides a concentration of voriconazole greater than the target minimum inhibitory concentration for about 10 days.
122. The method of any one of clauses 88 to 119, wherein the administration provides a concentration of voriconazole greater than the target minimum inhibitory concentration for about 14 days.
123. The method of any one of clauses 88 to 119, wherein the administration provides a concentration of voriconazole greater than the target minimum inhibitory concentration for about 16 days.
124. The method of any one of clauses 88 to 119, wherein the administration provides a concentration of voriconazole greater than the target minimum inhibitory concentration for about 21 days.
125. The method of any one of clauses 88 to 119, wherein the administration provides a concentration of voriconazole greater than the target minimum inhibitory concentration for about 28 days.
126. The method of any one of clauses 88 to 125, wherein the veterinary formulation is administered as a single unit dose.
127. The method of any one of clauses 88 to 125, wherein the veterinary formulation is administered as a multiple dose regimen.
128. The method of any one of clauses 88 to 127, wherein the method further comprises administration of a second therapeutic agent.
129. The method of clause 128, wherein the second therapeutic agent is selected from the group consisting of an oral antifungal agent, an anti-inflammatory agent, and an antibiotic.
130. The method of any one of clauses 88 to 129, wherein the method of treating is performed without co-administration of a topical antifungal to the animal.
131. The method of any one of clauses 88 to 130, wherein the therapeutically effective amount of the voriconazole is at a dose of about 1 mg.
132. The method of any one of clauses 88 to 130, wherein the therapeutically effective amount of the voriconazole is at a dose of about 2 mg.
133. The method of any one of clauses 88 to 130, wherein the therapeutically effective amount of the voriconazole is at a dose of about 2.5 mg.
134. The method of any one of clauses 88 to 130, wherein the therapeutically effective amount of the voriconazole is at a dose of about 3 mg.
135. The method of any one of clauses 88 to 130, wherein the therapeutically effective amount of the voriconazole is at a dose of about 4 mg.
136. The method of any one of clauses 88 to 130, wherein the therapeutically effective amount of the voriconazole is at a dose of about 5 mg.
137. The method of any one of clauses 88 to 130, wherein the therapeutically effective amount of the voriconazole is at a dose of about 7.5 mg.
138. The method of any one of clauses 88 to 130, wherein the therapeutically effective amount of the voriconazole is at a dose of about 10 mg.
139. The method of any one of clauses 88 to 130, wherein the therapeutically effective amount of the voriconazole is at a dose of about 0.001 to about 1 mg/kg of weight of the animal.
140. The method of any one of clauses 88 to 130, wherein the therapeutically effective amount of the voriconazole is at a dose of about 0.01 to about 0.1 mg/kg of weight of the animal.
141. The method of any one of clauses 88 to 130, wherein the voriconazole is released from the polymer at a rate between about 100 μg/day to about 10,000 μg/day.
Various embodiments of the invention are described herein as follows. In one embodiment described herein, a veterinary formulation is provided. The veterinary formulation comprises i) a therapeutically effective amount of voriconazole and ii) a polymer.
In another embodiment, a kit is provided. The kit comprises i) voriconazole and ii) a polymer.
In yet another embodiment, a method of treating fungal infection in an animal is provided. The method comprises the step of administering a veterinary formulation comprising i) a therapeutically effective amount of voriconazole and ii) a polymer to the animal.
In various embodiments, the veterinary formulation comprises a therapeutically effective amount of voriconazole. Voriconazole is generally known in the art as an azole antifungal agent and can be used to treat a number of fungal infections, including, for example, aspergillosis, candidiasis, coccidioidomycosis, histoplasmosis, penicilliosis, and infections caused by Scedosporium and Fusarium. 
As used herein, the term “voriconazole” refers to voriconazole base, pharmaceutically acceptable salts of voriconazole, other salts of voriconazole, metabolites of voriconazole, and prodrugs of voriconazole. The term “pharmaceutically acceptable salt” refers to an addition salt that exists in conjunction with the acidic or basic portion of voriconazole. Such salts include the pharmaceutically acceptable salts listed in HANDBOOK OF PHARMACEUTICAL SALTS: PROPERTIES, SELECTION AND USE, P. H. Stahl and C. G. Wermuth (Eds.), Wiley-VCH, New York, 2002 which are known to the skilled artisan. Pharmaceutically acceptable salts of an acid addition nature are formed when voriconazole and any of its intermediates containing a basic functionality are reacted with a pharmaceutically acceptable acid. Pharmaceutically acceptable acids commonly employed to form such acid addition salts include inorganic and organic acids. Pharmaceutically acceptable salts of a base addition nature are formed when voriconazole and any of its intermediates containing an acidic functionality are reacted with a pharmaceutically acceptable base. Pharmaceutically acceptable bases commonly employed to form base addition salts include organic and inorganic bases.
In addition to pharmaceutically acceptable salts, other salts are included in the present invention. They may serve as intermediates in the purification of compounds or in the preparation of other pharmaceutically-acceptable salts, or are useful for identification, characterization or purification.
The chemical structure of voriconazole is:

In the various embodiments, the voriconazole is present in the veterinary formulation at a therapeutically effective amount. As used herein, the term “therapeutically effective amount” refers to an amount which gives the desired benefit to an animal and includes both treatment and prophylactic administration. The amount will vary from one animal to another and will depend upon a number of factors, including the overall physical condition of the animal. The amount of voriconazole used for the therapeutically effective amount gives an acceptable effect and maintains desired response at a beneficial level. A therapeutically effective amount of the composition used in the methods of the present disclosure may be readily ascertained by one of ordinary skill in the art using publicly available materials and procedures.
In certain embodiments, the veterinary formulation further comprises an alcohol. In some embodiments, the alcohol is ethanol.
In various embodiments, the veterinary formulation comprises one or more second therapeutic agents. In some embodiments, second therapeutic agent is selected from the group consisting of an oral antifungal agent, an anti-inflammatory agent, and an antibiotic.
In various embodiments, the polymer is a thermogel polymer. Thermogel polymers (aka “thermogels”) are generally known in the art as polymers that exist in liquid phase when refrigerated and exist in solid phase when at room temperature. Typically, the steric hindrance of thermogel polymers combined with a low molecular weight prevents crystallization, and therefore provides their thermosensitivity. Thermogel polymers, when mixed together, provide various ranges in degradation time.
In some embodiments, the thermogel polymer is selected from the group consisting of poly(ethylene glycol) (PEG), poly(propylene glycol) (PPG), poly (N-isopropyl acrylamide) (PNIPAAm), poly(N,N-diethyl acrylamide) (PDEAM), poly(N-ethyl methacrylamide) (PNEMAM), poly(methyl vinyl ether) (PMVE), poly(2-ethoxyethyl vinyl ether) (PEOVE), poly(N-vinyl isobutyramide) (PNVIBAM), poly(N-vinyl n-butyramide) (PNVBAM), poly(N-vinyl caprolactam) (PNVCa), and poly (hydroxypropyl methacrylamide) (HPMA), poly(lactide-co-glycolide)-b-poly(ethylene glycol)-b-poly(lactide-co-glycolide) (PLGA-PEG-PLGA), poly(DL-lactide)-b-Poly(ethylene glycol)-b-Poly(DL-lactide) (P(DL)LA-PEG-P(DL)LA), and poly(lactide-co-caprolactone)-b-Poly(ethylene glycol)-b-Poly(lactide-co-caprolactone) (PLCL-PEG-PLCL).
In other embodiments, the thermogel polymer is a combination of two or more thermogel polymers selected from the group consisting of poly(ethylene glycol) (PEG), poly(propylene glycol) (PPG), poly (N-isopropyl acrylamide) (PNIPAAm), poly(N,N-diethyl acrylamide) (PDEAM), poly(N-ethyl methacrylamide) (PNEMAM), poly(methyl vinyl ether) (PMVE), poly(2-ethoxyethyl vinyl ether) (PEOVE), poly(N-vinyl isobutyramide) (PNVIBAM), poly(N-vinyl n-butyramide) (PNVBAM), poly(N-vinyl caprolactam) (PNVCa), and poly (hydroxypropyl methacrylamide) (HPMA), poly(lactide-co-glycolide)-b-poly(ethylene glycol)-b-poly(lactide-co-glycolide) (PLGA-PEG-PLGA), poly(DL-lactide)-b-Poly(ethylene glycol)-b-Poly(DL-lactide) (P(DL)LA-PEG-P(DL)LA), and poly(lactide-co-caprolactone)-b-Poly(ethylene glycol)-b-Poly(lactide-co-caprolactone) (PLCL-PEG-PLCL).
In certain embodiments, the thermogel polymer is poly(lactide-co-glycolide)-b-poly(ethylene glycol)-b-poly(lactide-co-glycolide) (aka “PLGA-PEG-PLGA”). The structure of PLGA-PEG-PLGA is as follows:

In some embodiments, the PLGA-PEG-PLGA has a molecular weight of 1100:1000:1100. For example, a PLGA-PEG-PLGA with a molecular weight of 1100:1000:1100 can be referred to as PolyVivo AK24 (i.e., Poly(lactic-co-glycolic acid)-b-Poly(ethylene glycol)-b-Poly(lactic-co-glycolic acid) copolymers, with a molecular weight of components at a ratio of 1100:1000:1100 Da and 3:1 lactide:glycolide; Akina, Inc., West Lafayette, Ind.).
In other embodiments, the PLGA-PEG-PLGA has a molecular weight of 1500:1500:1500. For example, a PLGA-PEG-PLGA with a molecular weight of 1500:1500:1500 can be referred to as PolyVivo AK19 (i.e., Poly(lactic-co-glycolic acid)-b-Poly(ethylene glycol)-b-Poly(lactic-co-glycolic acid) copolymers, with a molecular weight of components at a ratio of 1500:1500:1500 Da and 1:1 lactide:glycolide; Akina, Inc., West Lafayette, Ind.).
In yet other embodiments, the PLGA-PEG-PLGA has a molecular weight of 1600:1500:1600 Da. For example, a PLGA-PEG-PLGA with a molecular weight of 1600:1500:1600 can be referred to as PolyVivo AK088 (i.e., Poly(lactic-co-glycolic acid)-b-Poly(ethylene glycol)-b-Poly(lactic-co-glycolic acid) copolymers, with a molecular weight of components at a ratio of 1600:1500:1600 Da and LG 75:25; Akina, Inc., West Lafayette, Ind.).
In other embodiments, the PLGA-PEG-PLGA has a molecular weight of 1700-1500-1700 Da. For example, a PLGA-PEG-PLGA with a molecular weight of 1700-1500-1700 can be referred to as PolyVivo AK097 (i.e., Poly(lactic-co-glycolic acid)-b-Poly(ethylene glycol)-b-Poly(lactic-co-glycolic acid) copolymers, with a molecular weight of components at a ratio of 1700-1500-1700 Da and LA:GA 15:1; Akina, Inc., West Lafayette, Ind.).
In some embodiments, the PLGA-PEG-PLGA is a combination of two different PLGA-PEG-PLGA compositions, wherein the first PLGA-PEG-PLGA composition and the second PLGA-PEG-PLGA composition are selected from the group consisting of a PLGA-PEG-PLGA with a molecular weight of 1100:1000:1100 Da, a PLGA-PEG-PLGA with a molecular weight of 1500:1500:1500 Da, a PLGA-PEG-PLGA with a molecular weight of 1600:1500:1600 Da, and a PLGA-PEG-PLGA with a molecular weight of 1700-1500-1700 Da.
In other embodiments, the PLGA-PEG-PLGA is a combination of two different PLGA-PEG-PLGA compositions, wherein the first PLGA-PEG-PLGA composition has a molecular weight of 1100:1000:1100 and the second PLGA-PEG-PLGA composition has a molecular weight of 1500:1500:1500. In certain aspects, the ratio of the first PLGA-PEG-PLGA composition and the second PLGA-PEG-PLGA composition is about 1:1. In other aspects, the ratio of the first PLGA-PEG-PLGA composition and the second PLGA-PEG-PLGA composition is about 2:1. In other aspects, the ratio of the first PLGA-PEG-PLGA composition and the second PLGA-PEG-PLGA composition is about 3:1.
In yet other embodiments, the PLGA-PEG-PLGA is at a ratio of 1:1 (lactide:glycolide). In some embodiments, the PLGA-PEG-PLGA is at a ratio of 2:1 (lactide:glycolide). In other embodiments, the PLGA-PEG-PLGA is at a ratio of 3:1 (lactide:glycolide). In yet other embodiments, the PLGA-PEG-PLGA is at a ratio of 15:1 (lactide:glycolide).
In certain embodiments, the thermogel polymer is poly(DL-lactide)-b-Poly(ethylene glycol)-b-Poly(DL-lactide) (aka “P(DL)LA-PEG-P(DL)LA”). The structure of P(DL)LA-PEG-P(DL)LA is as follows:

In some embodiments, the P(DL)LA-PEG-P(DL)LA has a molecular weight of 1700-1500-1700. For example, a P(DL)LA-PEG-P(DL)LA with a molecular weight of 1700-1500-1700 can be referred to as PolyVivo AK100 (i.e., Poly(DL-lactide)-b-Poly(ethylene glycol)-b-Poly(DL-lactide) triblock copolymers, with a molecular weight of components at a ratio of 1700-1500-1700 Da; Akina, Inc., West Lafayette, Ind.).
In certain embodiments, the thermogel polymer is poly(lactide-co-caprolactone)-b-Poly(ethylene glycol)-b-Poly(lactide-co-caprolactone) (aka “PLCL-PEG-PLCL”). The structure of PLCL-PEG-PLCL is as follows:

In some embodiments, the PLCL-PEG-PLCL has a molecular weight of 1700-1500-1700. For example, a PLCL-PEG-PLCL with a molecular weight of 1700-1500-1700 can be referred to as PolyVivo AK109 (i.e., Poly(lactide-co-caprolactone)-b-Poly(ethylene glycol)-b-Poly(lactide-co-caprolactone), with a molecular weight of components at a ratio of 1700-1500-1700 Da and 60:40 CL:LA; Akina, Inc., West Lafayette, Ind.).
In various aspects, the thermogel polymer has a gelation set point at a temperature of about 30° C. to about 40° C. As used herein, the gelation set point refers to a temperature or a temperature range at which conversion of a thermogel from its liquid state to its solid state occurs. In other aspects, the thermogel polymer has a gelation set point at a temperature of about 33° C. to about 44° C. In certain aspects, the thermogel polymer has a gelation set point at a temperature of about 33° C. to about 36° C. In other aspects, the thermogel polymer has a gelation set point at a temperature of about 31° C. to about 42° C. In yet other aspects, the thermogel polymer has a gelation set point at a temperature of about 27° C. to about 45° C.
In various embodiments, the veterinary formulation further comprises one or more dissolution additives. Generally, a dissolution additive may be added to the veterinary formulation in order to modify the dissolution speed of the thermogel polymer(s) in the formulation. In some embodiments, the one or more dissolution additives is selected from the group consisting of N-methylpyrolidinone (NMP), mannitol, and mPEG-P (DL) La. In one embodiment, the mPEG-P (DL) La is mPEG-P (DL) La (2000-2200 Da).
In some embodiments, the veterinary formulation is single-use formulation that is intended to be given to an animal in a single administration. In other embodiments, the veterinary formulation is multi-use formulation that is capable of being given to an animal in a single administration or in multiple administrations. Two or more polymers may be combined to achieve the correct temperature for the most efficacious product or for the desired immediate and/or extended release times.
In some embodiments, the veterinary formulation is a controlled release formulation. A controlled release formulation is intended to more slowly release the voriconazole of the veterinary formulation to the animal. In some aspects, the controlled release formulation releases voriconazole from veterinary formulation for about 7 days. In other aspects, the controlled release formulation releases voriconazole from veterinary formulation for about 10 days. In yet other aspects, the controlled release formulation releases voriconazole from veterinary formulation for about 14 days. In some aspects, the controlled release formulation releases voriconazole from veterinary formulation for about 21 days. In yet other aspects, the controlled release formulation releases voriconazole from veterinary formulation for about 28 days.
In some embodiments, the veterinary formulation is an injectable formulation. As used herein, an injectable formulation refers to a formulation with the ability to be introduced under pressure at a site of an animal (as by introduction using a syringe). “Syringe” refers to any device that may be used to inject or withdraw compositions of the present disclosure. In some aspects, the injectable formulation is configured for injection in a subconjunctival space (SCS) of an animal. As used herein, the subconjunctival space generally refers to the area in an eye of the animal that is located between the conjunctiva and the sclera. In some embodiments, the SCS is a dorsal bulbar SCS. In other embodiments, the SCS is a ventral bulbar SCS.
In another embodiment, a kit is provided. The kit comprises i) voriconazole and ii) a polymer. The previously described embodiments of the veterinary formulation are applicable to the kit described herein.
In various embodiments, the kit further comprises one or more dissolution additives. In some embodiments, the one or more dissolution additives is selected from the group consisting of N-methylpyrolidinone (NMP), mannitol, and mPEG-P (DL) La. In one embodiment, the mPEG-P (DL) La is mPEG-P (DL) La (2000-2200 Da).
In certain aspects, the polymer, for example the polymer provided in the kit, is a liquid. In various embodiments, the liquid polymer is configured to form a gel deposit upon administration to an animal. For example, when the liquid polymer is a thermogel polymer, the liquid polymer undergoes conversion to a gel deposit upon reaching an appropriate temperature.
In some embodiments, the gel deposit is formed at a temperature of about 30° C. to about 40° C. In other embodiments, the gel deposit is formed at a temperature of about 33° C. to about 44° C. In yet other embodiments, the gel deposit is formed at a temperature of about 33° C. to about 36° C. In other embodiments, the gel deposit is formed at a temperature of about 31° C. to about 42° C. In yet other embodiments, the gel deposit is formed at a temperature of about 27° C. to about 45° C.
In certain aspects, the kit further comprises instructions for combination of the voriconazole, the polymer, and any other element as described herein.
In another embodiment, a method of treating a fungal infection in an animal is provided. The method comprises the step of administering a veterinary formulation comprising i) a therapeutically effective amount of voriconazole and ii) a polymer to the animal. The previously described embodiments of the veterinary formulation and of the kit are applicable to the method of treating a fungal infection in an animal described herein. In certain aspects, the veterinary formulation is formed from the kit as described herein.
In various embodiments, the fungal infection is caused by an Aspergillus species. In other embodiments, the fungal infection is caused by a Fusarium species. In yet other embodiments, the fungal infection is caused by a Penicillium species. In some embodiments, the fungal infection is caused by a Candida species.
In certain aspects, the fungal infection is an ocular infection. In some embodiments, the fungal infection is causes keratomycosis in the animal. Keratomycosis, sometimes referred to as fungal keratitis, is generally known as a fungal infection of the cornea (i.e., the anterior part of the eye which covers the pupil).
In various embodiments, the animal is an equine. In some embodiments, the equine is a horse. In other embodiments, the equine is a donkey. In yet other embodiments, the equine is a zebra.
In some aspects, the animal is a feline. In other aspects, the animal is a canine. In yet other aspects, the animal is a camelid. In some embodiments, the camelid is selected from the group consisting of dromedary camels, Bactrian camels, wild Bactrian camels, llamas, alpacas, vicuñas, and guanacos. In other embodiments, the camelid is a llama. In yet other embodiments, the camelid is an alpaca.
In certain aspects, the administration to the animal is an injection. In some aspects, upon the injection to the animal, the polymer of the veterinary formulation is a liquid. In various aspects, the liquid polymer forms a gel deposit in the animal subsequent to the injection. In some embodiments, the gel deposit is formed at a temperature of about 30° C. to about 40° C. In other embodiments, the gel deposit is formed at a temperature of about 33° C. to about 44° C. In yet other embodiments, the gel deposit is formed at a temperature of about 33° C. to about 36° C. In other embodiments, the gel deposit is formed at a temperature of about 31° C. to about 42° C. In yet other embodiments, the gel deposit is formed at a temperature of about 27° C. to about 45° C.
In some embodiments, the injection is in a subconjunctival space (SCS). In various embodiments, the SCS is a dorsal bulbar SCS. In other embodiments, the SCS is a ventral bulbar SCS.
In certain aspects, the voriconazole diffuses through a cornea of the animal. In other aspects, the voriconazole diffuses through a sclera of the animal.
In some embodiments, the administration provides a concentration of voriconazole greater than the target minimum inhibitory concentration for about 7 days. In other embodiments, the administration provides a concentration of voriconazole greater than the target minimum inhibitory concentration for about 10 days. In yet other embodiments, the administration provides a concentration of voriconazole greater than the target minimum inhibitory concentration for about 14 days. In some embodiments, the administration provides a concentration of voriconazole greater than the target minimum inhibitory concentration for about 16 days. In other embodiments, the administration provides a concentration of voriconazole greater than the target minimum inhibitory concentration for about 21 days. In yet other embodiments, the administration provides a concentration of voriconazole greater than the target minimum inhibitory concentration for about 28 days.
In certain aspects, the veterinary formulation is administered as a single unit dose. In other aspects, the veterinary formulation is administered as a multiple dose regimen. In yet other aspects, the method further comprises administration of a second therapeutic agent. In some embodiments, the second therapeutic agent is selected from the group consisting of an oral antifungal agent, an anti-inflammatory agent, and an antibiotic. In various aspects, the method of treating is performed without co-administration of a topical antifungal to the animal.
In certain embodiments, the therapeutically effective amount of the voriconazole is at a dose of about 1 mg. In some embodiments, the therapeutically effective amount of the voriconazole is at a dose of about 2 mg. In other embodiments, the therapeutically effective amount of the voriconazole is at a dose of about 2.5 mg. In yet other embodiments, the therapeutically effective amount of the voriconazole is at a dose of about 3 mg. In some embodiments, the therapeutically effective amount of the voriconazole is at a dose of about 4 mg. In other embodiments, the therapeutically effective amount of the voriconazole is at a dose of about 5 mg. In yet other embodiments, the therapeutically effective amount of the voriconazole is at a dose of about 7.5 mg. In some embodiments, the therapeutically effective amount of the voriconazole is at a dose of about 10 mg. In other embodiments, the therapeutically effective amount of the voriconazole is at a dose of about 0.001 to about 1 mg/kg of weight of the animal. In yet other embodiments, the therapeutically effective amount of the voriconazole is at a dose of about 0.01 to about 0.1 mg/kg of weight of the animal. In other embodiments, the voriconazole is released from the polymer at a rate between about 100 μg/day to about 10,000 μg/day.